22 male Flashcards
inflammatory diseases of male reproductive
viral
bacterial
viral herpis genitalis
1 or 2
3 Ms of hsv infected cell and known as
Herpes genitalis
HSV-2»_space;> HSV-1
Multiple vesicles and painful ulcer develop 3 to 7 days after infection and heal spontaneously in 1 to 3 weeks.
During the acute infection the virus migrates to the regional lumbosacral nerve ganglia and establishes a latent infection.
margination
molding
multinucealtion
coedry bodies
Human papilloma virus (HPV)
Oncogenic virus
Causes condyloma acuminatum, precancerous lesion and cancer
HPV cells known as
and why named so
koliocytes
kolio means hollow
cyte cell
hollow cells because cells have perinuclear hollow region
Genome of HPV
what makes it oncogenic
E6 inactivate P53 and telomerase expression,
E7 inactivate Rb and
E5 perinuclear vacuole (halo)
Pox virus (mulluscum contagiosum virus)
Cause mulluscum contagiosum
Dome-shaped papules with a dimpled center.
mcv2 std
Chancroid (Soft Chancre)
Chancroid (Soft Chancre)
Gram-negative bacillus, Haemophilus ducreyi
Cause painful genital ulcer
Lymphogranuloma veneurum (LGV):
C. trachomatis (L1, L2 and L3)
Starts as painless papules that develops an ulcer.
After a few days painful regional lymphadenopathy develop (necrotizing granulomatous inflammation of the inguinal lymphatics and lymph nodes)
Rectal stricture may be seen with perianal involvement.
grooves sign
enlarged LN splited by pouparts ligament
Granuloma inguinale (Donovanosis)
Caused by intracellular gram-negative bacterium Klebsiella granulomatis.
Non suppurative painless genital ulcer and beefy-red appearance
donovan bodies
safety pin like bodies inside monocytes
Urethritis
define
classification
accompanied by
Urethritis = Inflammation of urethra
Classified as gonococcal and non gonococcal
Present with urethral discharge, and dysuria.
Urethritis is often accompanied by cystitis in women and by prostatitis in men.
Example of non infectious urethritis is
reactive arthritis (formerly Reiter syndrome), which is associated with the clinical triad of arthritis, conjunctivitis, and urethritis
causes of urethral stricture
inflammatory
traumatic
catheter
post op prostectomy
bulbar
membraneous
all
prostatic
Prostatitis
define
types
difference between them
= Inflammation of prostate
Acute bacterial prostatitis
Presents with dysuria, frequency, urgency, low back pain.
Warm, tender, enlarged prostate on digital rectal exam.
Prostatic secretions show WBCs and culture reveals bacteria.
Chronic prostatitis
Presents as dysuria with pelvic or low back pain
Prostatic secretions show WBCs, but cultures are negative.
Epididymitis
define
present as
clinical exam for prostitis
in what disease epididymis affcted first
Epididymitis = Inflammation of epididymis
Presents with localized pain and tenderness over posterior testis.
Positive Prehn sign (pain relief with scrotal elevation).
May progress to involve testis.
Tuberculosis - epididymis involved first with caseating granuloma on histology
Orchitis
define
presentation
types
what disease is testis involved first
inflammation of testis
Orchitis presents with testicular pain and swelling.
Granulomatous (autoimmune) orchitis-
Mumps orchitis -
Syphilis - testis is involved first with obliterative endarteritis and gumma on histology.
granulomatous and mumps orchitis
characterized by granulomas involving the seminiferous tubules. Idiopathic (antisperm antibodies (ASA))
rare in males < 10 years old. Most often seen 1 week after parotid glands enlagment. Infertility risk.
balanitis
inflammation of glans penis
phimosis
and paraphimosis
inhabilty to retract foreskin
inability to reduce the forskin back to anatomical postion
Fournier gangrene
Polymicrobial necrotizing fasciitis involving the genital areas and perineum
Surgical emergency
congenital penile abnormality
hypospadias
epispadias
hypospadias
cause
where
failure of urethral folds to fuse
opening under
epispadias
where
cause
assoc.tion
faulty positioning of genital tubercle
assoc. with extrophy of bladder
Invasive Squamous Cell Carcinoma
Most common type of penile cancer.
40 to 70 years of age
< 1% of all cancers of the male
in some parts of Asia, Africa, and South America, penile cancer accounts for 10% to 20% of male malignancies
scrotal carcinoma
Scrotal carcinoma, also known as squamous cell carcinoma of the scrotum, is a rare form of cancer that affects the skin of the scrotum. It is primarily associated with occupational exposure to certain substances, particularly in chimney sweepers during the industrial revolution.
Cryptorchidism
Cryptorchidism
(Gr: kryptos = hidden and orchis = testicle)
Descent failure of one or both testes
80% are unilateral and 20% are bilateral
Most common congenital male reproductive abnormality
Most cases are clinically asymptomatic and discovered only on physical examination.
An undescended testis is called …………. when it can be manipulated into scrotum where it remains without tension. On the other hand, when it can be manipulated into upper scrotum but retracts when released, it is called ……………
retractile
gliding
On gross examination, the cryptorchid testis is small and fibrotic. Histologically, there is marked reduction in the number of germ cells.
why?
Impaired spermatogenesis (since sperm develop best at temperatures < 37°C)
~ 80% descend by the first year of life making the actual incidence about ~1%
Otherwise, orchiopexy performed before 2 years of age.
Benign intrascrotal lesions
hydrocele
spermatocele
varicocele
Varicocele
define
where
epidemology
causes
looks like what on
Dilated spermatic vein in pampiniform plexus due to impaired drainage
Most common cause of intrascrotal enlargement in adult males
Most often on left side
Can cause infertility because of temperature
Diagnosed by standing clinical exam/Valsalva maneuver (distension on inspection and “bag of worms” on palpation) or ultrasound
Hydrocele
DEFINE
types
Serous fluid collection within the tunica vaginalis
Congenital hydrocele: Common cause of scrotal swelling in infants, due to incomplete obliteration of processus vaginalis. Most spontaneously resolve within 1 year.
Acquired hydrocele: Scrotal fluid collection usually 2° to infection, trauma, tumor, due to blockage of lymphatic drainage
Hematocele when the fluid is blood.
Spermatocele
Spermatocele = Cyst due to dilated epididymal duct or rete testis. Filled with spermatozoa
Testicular torsion
due to
looks like
Rotation of testicle around spermatic cord and vascular pedicle.
Commonly presents 12–18 years old.
May occur after an inciting event (eg, trauma) or spontaneously.
Usually due to congenital failure of testes to attach to the inner lining of the scrotum (via the processus vaginalis)
Characterized by acute (sudden), severe pain, high-riding testis, and absent cremasteric reflex.
bell capper
types of testicular tumorr
germ cell tumor
sex cord tumor
germ cell tumors type
seminomal and non seminomal
Seminoma
define
pain?
analogue
occurance
produce what
prognosis
Malignant and painless tumor
Most common testicular tumor
Analogous to ovarian dysgerminoma and extragenital germinoma.
Does not occur in infancy
Placental alkaline phosphatase (PLAP) and 15% HCG
Excellent prognosis - Highly radiosensitive with late metastasis.
Embryonal carcinoma
define
pain
produces
prognosis
differnece from seminoma
Comprised of immature primitive cells that may produce glands
Malignant and Painful tumor
Pure embryonal carcinoma is rare
May be associated with increased hCG and normal AFP levels when pure (increased AFP when mixed).
Aggressive with early hematogenous spread.
Chemotherapy may result in differentiation into another type of germ cell tumor (e.g., teratoma).
there is necrosis with hemorhage
Teratoma
define
when malignat and when benign
Composed of mature fetal tissue derived from two or three embryonic layers.
Mature teratoma may be malignant in adult males.
Benign in children and females.
Yolk sac (endodermal sinus) tumor
define
epidemology
bodies seen
what is elevated
Most common testicular tumor in children < 3 years old
Schiller-Duval bodies resemble primitive glomeruli are seen on histology
AFP is characteristically elevated
Aggressive tumor
In adults is mixed with embryonal carcinoma
Choriocarcinoma
define
metastasize ?
tumor marker
may cause
Malignant tumor of syncytiotrophoblasts and cytotrophoblasts (placenta-like tissue, but no villi).
Early hematogenous metastasis
Tumor marker HCG
May produce gynecomastia and hyperthyroidism
Sex cord stromal tumor
epidemology ben or mal?
types
5% of all testicular tumors
Mostly benign
Leydig cell tumor
Sertoli cell tumor (androblastoma) is comprised of tubules and is usually clinically silent.
leydig cell tumor
produce?
causes?
histologically what cells seen
usually produces androgen or estrogens , causing precocious puberty in children or gynecomastia in adults.
Primary testicular lymphoma (PTL)
epidemology
type
laterality
Most common testicular tumor in males > 60 years old.
Typically diffuse large B-cell lymphoma (DLBCL).
Usually bilateral, and most have disseminated at the time of diagnosis.
The most common benign paratesticular tumor is
adenomatoid tumor.
The most common malignant paratesticular tumors are ………………….in children and ………………. in adults.
rhabdomyosarcomas
liposarcomas
